Basic Information
| Provider Information | |||||||||
| NPI: | 1386632974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMIATEK | ||||||||
| FirstName: | GEOFF | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4605 SAWMILL RD | ||||||||
| Address2: | |||||||||
| City: | UPPER ARLINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148278700 | ||||||||
| FaxNumber: | 6148278701 | ||||||||
| Practice Location | |||||||||
| Address1: | 4604 SAWMILL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148278700 | ||||||||
| FaxNumber: | 6148278701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2005 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 009572 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT 009572 | 01 | OH | PHYSICAL THERAPY LICENSE | OTHER |